Not long ago, medical students were taught the rule of thumb that if a person younger than about 60 remained conscious after head trauma, he likely did not suffer any permanent injury. As psychological testing and radiologic imaging technology became more sophisticated over the years, however, this old straw had to be discarded. Of course, my usual reaction is if mild head trauma causes measurable brain injury, why aren’t more of these patients offered hyperbaric oxygen therapy, the one treatment option that might actually be helpful? More than a million Americans suffer from mild head trauma annually and perhaps 20% of these folks will never return to work.
My purpose today is not to whine about medical politics, but to bring attention to an article that appeared in the September 2009 issue of Radiology. The study looked at 20 patients with mild head injuries, which was carefully defined, who all had diffusion tensor imaging. That’s a mouthful, so let’s hold it here for a minute.
Diffusion tensor imaging is a type of fMRI (functional MRI) that was first performed in 1991, but took almost another decade of hard work to develop to the point of relative widespread use. Even today, fMRI is not available in all hospitals, but nevertheless, this article demonstrates just how useful DTI can be. The patients seen in this study all had normal CT and MRI scans of the brain. In fact, the problem with mild head trauma is that there is no test that reliably predicts which patients are going to have long term problems. Enter the fMRI and more specifically DTI.
The 20 head-injured patients were matched with controls and subjected to a battery of psychological tests designed to assess executive function (errors of omission, number of maze trials, and maze time.) The authors found 15 abnormal areas in the patients, compared to the controls, and were able to correlate injuries in the prefrontal cortex with abnormalities in measured executive function.
Although this is a small study, it demonstrates that as medicine advances, many patients with mild head injuries and normal brain scans do in fact have objective and measurable injuries. We know that many of these patients will suffer for the rest of their lives. Why not give them a chance with hyperbaric oxygen?